Individual
MR. BRUCE JOHN GRANDSTAFF SR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
7905 N MEADOWLARK WAY, STE B, COEUR D ALENE, ID 83815
(208) 772-6015
(208) 772-6016
Mailing address
7905 N MEADOWLARK WAY, STE B, COEUR D ALENE, ID 83815
(208) 772-6015
(208) 772-6016
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA 668
ID
Other
Enumeration date
02/24/2006
Last updated
07/08/2007
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